What Does Medicare Part C Cover?

We’re going to continue our series on Medicare today by taking a closer look at Medicare Part C.

Unlike Medicare Part A and Medicare Part B, Medicare Part C is not a program that you enroll with Social Security. Rather, it’s another name for what’s known as the Medicare Advantage program, offering an alternative to traditional Medicare coverage.

With Medicare Advantage, you’re still enrolled in Medicare, but you’ll get benefits through a private insurance plan instead of original Medicare.

These plans generally have you choose a primary care physician, restricting your choices for other doctors or providers. If you see providers outside your network, you will likely have to pay more, or even run the risk that your care isn’t covered.

What’s covered by Medicare Part C?

Medicare Part C includes all the benefits of Medicare Part A and Part B, including:

Hospital stays

Skilled nursing care

Home health care

Doctor visits

Outpatient care

Screening and lab tests

Many Medicare Part C plans also include prescription drug coverage and may also offer coverage for dental, vision and hearing, wellness services and a nurses helpline.

These plans are similar to the group insurance benefits offered by employers. There is typically a network of providers available to you. Medicare Part C recipients will need to pay copays for several regular services such as doctor’s visits, hospital stays, surgery, ambulance rides and lab work.

How do I become eligible for Medicare Part C?

Any Medicare beneficiary can purchase a plan no matter their age, as long as they meet these criteria:

Enrollment in both Medicare Part A and Part B. There’s a common misconception that you can drop Medicare Part B if you enroll in Part C.

Residence within the plan’s service area. Medicare Part C eligibility is based on the address you have on file with Social Security. The plan you pick needs to operate in your home county.

Lastly, Medicare Part C is not open to anyone with end-stage renal disease.

Keep in mind that there’s an election period for Medicare Advantage plans. You can enroll during your initial enrollment period into Medicare, or during the annual election period in the fall.

In some cases, you might be eligible for a special election period, if you’ve lost your plan for some reason or if you’ve moved out of state.

How much will Medicare Part C cost?

Because you’re agreeing to be treated in your plan’s network and pay co-pays as you go, Medicare Part C premiums tend to be lower than Medigap plans.

Under Medicare Part C, you’ll pay for:

Medicare Part B premiums

Some plans may require a deductible before benefits kick in

Copays for medical services upon treatment

Some services may ask for as much as 20 percent coinsurance

With Medicare Part C, your annual out of pocket maximum won’t surpass $6,700. Original Medicare places no such caps on out of pocket maximums, which makes Medicare Part C a more enticing option than original Medicare on its own.

Medicare Part C, like parts A and B, can be tough to navigate, which is why we’re happy to be able to offer some insights into this coverage, just like we’re happy to make our customers lives easier with our various accessibility products, from stair lifts to platform lifts and more.

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